From top-of-the-line healthcare centres in New York to the Gudalur Adivasi Hospital in Tamil Nadu was one hell of a jump for Drs Nandakumar and Shylaja Menon. But it's been 12 years, and they're still working in their dream village

The ACCORD team were in the midst of a massive argument. We needed a decent hospital but it did not fit into the gospel of community health. Hospitals are unsustainable, a drain on energy and impossible to fund. The alternative was to let people die of callous neglect in the government hospital. "And of course," Deva cynically pointed out, "surgeons and gynaecologists are lining up to work in Gudalur."

The next week, Dr Nandakumar Menon arrived, a jhola on his shoulder, sporting dusty, rubber bathroom chappals, having bus-hopped from Kerala to Gudalur, Tamil Nadu.He was the answer to our prayers we knew. And he was nothing like the stereotypical American NRI we had in mind. Still, what would NRI doctors, straight out of Westchester County New York, home of the Rockefellers and now the Clintons, make of us, in the back of beyond, with no facilities at all to speak of? That was uppermost on all our minds.

Nandakumar had worked as a surgeon in New York for 10 years. At an emergency trauma centre where helicopters flew in accident victims. Shyla was a gynaecologist. From Westchester County, New York, to Gudalur, Tamil Nadu, was one hell of a jump.

Doctors Nandakumar and Shylaja Devi Menon had returned from America to India, to begin a search for their dream village. Amazingly, after a decade in the land of milk and honey, both of them were totally unpretentious. No phoney accents, no NRI hang-ups or complaints. They were the ideal couple and ACCORD jumped at the god-given offer to start a hospital in Gudalur.

The plus points were (not necessarily in that order) a beautiful locale to live and work in, a warm, caring team for support, and a wonderful adivasi community to work with.

The unexciting part was no decent school for the kids. Minimal facilities. Erratic electricity. Perennial water problems. They weighed things up and decided it was worth giving it a try.

So with Roopa and Deva, they decided to start the Gudalur Adivasi Hospital. It was an uphill task. The girls they took on to be nurses were literate. They'd made it to high school. But their maths and English were abysmal. To teach them maths, Roopa's mother cut a cake to explain fractions so they could calculate drips. Very basic concepts had to be worked on from scratch.

The decision to employ only adivasis was a political one. For the community to feel that it was THEIR hospital. For them to have ownership over it. For it to have an adivasi ambience. To make a statement to the rest of the world in Gudalur. That adivasis WERE capable of moving out of, and up, from the bottom-most rung of the ladder that our society had consigned them to.

But theory was one thing and practice another. The operating room was a tiny narrow ward where the home-made operating table fitted. Only just. When NK performed an operation, or Shyla did a Caesarian section, the doctor dealing with the anaesthesia sat under the table holding the bottle of ether. There was no air-conditioning. No room for a fan even. One person mopped brows! But at the end of a successful day everyone glowed with a sense of achievement. Of a job well done.

Once, in 1990, soon after the hospital was opened, a forest-dwelling patient arrived, his face ripped off by a bear. It was a ghastly sight. The government hospital had sutured his face without cleaning the wounds. Unbelievable but typical. Then they'd found him gasping for breath and told him to go 40 kms to Ooty to the district hospital. The family brought the man to our hospital. NK found that one of the puncture wounds was into the trachea and did an emergency tracheostomy. He then had to remove all the stitches the government ward aide had put in, clean the dirty wounds and leave them open. He'd barely finished, when in an unbelievably nightmarish coincidence, another bear attack victim walked in from another part of the taluka. Days later, the first patient ran away without removing his tracheostomy. The emergency was over, he could not stand life outside his village surrounded by strange people. He never ever came back and the team speculated about the fugitive patient for years to come.

There were frustrating days. Some months into the nurses training, a disgusted NK announced, "This is ridiculous, we're running a hospital. With life and death situations. These girls will never manage the levels needed." Exactly a year later he was jubilant. In a complicated operation, Ambika, the star trainee, had passed him an instrument she had seen used only once before in an identical procedure. Even a junior surgeon may not have known which instrument to pass. NK's theory was that Ambika's photographic memory had caused an almost reflex action. Possibly, the adivasis had very uncluttered minds so they absorbed things they saw in practice, rather than book knowledge.

Twelve years down the line, Ambika and some of the other nurses conduct deliveries on their own. Nandakumar still gets impatient when things don't work like they used to do in New York. Medically and from a surgeon's point of view, it is often frustrating when people die unnecessary, senseless deaths due to lack of facilities or funds.

But Shyla and Nandakumar are happy to be back. When the records show that our team has a better track record with maternal mortality and infant deaths than the national average, when diarrhoea deaths have almost ceased, when adivasis come voluntarily to the hospital rather than running away or preferring to die unnecessary deaths in the security of their own little verandahs, there is the sense of a decade of work rewarded. Of things that have gone right more often than wrong. And of a job fairly well done, to the best of our often stretched capabilities.

The hospital has attracted young doctors inspired by NK and Shyla, the challenging work, and the fantastic teamspirit prevalent at the Gudalur Adivasi Hospital. Emma, from faraway Scotland, Henry from St John's, Bangalore, paediatrician Sreedhar from Vellore, Mary and Rajkumar from Oddanchatram, Bharat and Deepa from the UK, Gail from Canada and even a gold medallist ENT specialist Ramesh from the AIIMS, Delhi. Dr P G Premila, head of the paediatric department, government hospital, Trivandrum, spent two years training nurses and healthworkers and continues to return with unfailing regularity to a hospital she loves.

Sometimes there is frustration. As when we see malnutrition returning because of rampant unemployment in the tea garden slump and the district-wide recession. There are good times and very bad, frustrating times too. But, in spite of all the ups and downs Doctors Shyla and Nandakumar Menon always feel good about returning to Gudalur. And to the Nilgiris. It's a good feeling to be coming home.

After 12 years on the job, NK and Shyla look forward to handing over some of the day-to-day work to a younger generation of doctors. Anyone who's willing to work hard and deal with an often frustrating, always challenging but mostly rewarding work situation, will be welcomed with open arms. We don't promise a bed of roses, but most of our good doctors keep coming back.